Good health isn't all about doctors and nurses – housing can play a critical part in promoting health and wellbeing. Photograph: Richard Gardner / Rex Features

When Midland Heart set up stall at two health conferences last year, delegates were confused about why the housing association was there.

"When we started to explain, the penny dropped," recalls Neil Tryner, Midland Heart's head of business development. "Health is about housing as much as it is about doctors," he says.

Evidence suggests that when housing and health professionals work together, it saves money and patients enjoy better outcomes. A recent National Housing Federation (NHF) report on integrated housing, health and care services received by five individuals – including at Midland Heart – found it saved up to £17,992 a year per person compared with traditional services. And that's before you count benefits like improved mental health and wellbeing.

The pressure for housing and health professionals to join forces is on. Policy makers favour joint initiatives – not least because the NHS must find £20bn in efficiency savings by 2014. Last year, the Commons health select committee said a fully integrated system was "essential".

Yet while some housing providers have made progress – and savings – via joint-working, others have not. Often the relationship between housing and health is uneasy and links hard to forge. So what are the challenges of widespread integration, and can they be met?

"The fundamental barrier we still need to overcome is people understanding what housing does, and the breadth and depth of the best housing providers," argues Domini Gunn, director of health and wellbeing at the Chartered Institute of Housing. Without this, she adds, health professionals will continue to "push housing out" and default to expensive "institutionalised" services, such as residential care homes.

It's a two-way problem: "Both housing and health are complex systems, and the risk is that we look opaque to each other," says Jake Eliot, policy leader at the NHF, which is working with the NHS Federation, a membership body, to improve housing and mental health links.

Problems include language and cultural differences. For example, Eliot explains: "'Residential' in health applies to any non-hospital setting; in housing it suggests residential care". Different budgets and funding mechanisms are another barrier, Eliot says, which requires both sides to identify common ground and potential solutions if they are to work together.

However, NHS reform makes it an especially tricky time to tackle differences. "There are just so many other issues that commissioning groups will probably find more important than this at the moment," says one Nottingham-based GP.

Richard Humphries, assistant director of policy at healthcare charity The King's Fund, agrees that reorganisation is a distraction, but adds: "On the positive side, I do sense a degree of commitment and goodwill."

But the onus is on housing to make the first move. "The key is meeting those [health] individuals who really want to make it work," advises Tryner, who met two such professionals on his conference stall and with whom he is set to launch re-ablement services at two acute-needs hospitals in the Midlands. An example of a re-ablement service might include installing a 'key-safe' that allows carers to access a house without the resident having to get up to answer the door. The trio aim to help the hospitals discharge medically fit patients that are currently blocking beds.

Both the NHF and CIH are working with health organisations, including the NHS Federation and local commissioners, to, as Eliot puts it, "work out where in the system [housing's] offer fits."

"We need to think very differently about how we present our offer," argues Gunn. "It would be helpful to agree on three of four priorities that we're all going to work on … At the moment we're all using different statistics, so we're working on what we hope will be a universal cost benefit analysis [of providing integrated services]."

Kevin Mulvenna, senior policy officer at Bristol city council, says this would help. "You've got to demonstrate that it will make a difference, not just speculate that 'this might be nice'," he says.

The stock-owning authority runs several health and housing initiatives, including a falls prevention service for private tenants at a fifth of the cost of treating a fall on the NHS. "If you can provide evidence then you're pushing at an open door," explains Mulvenna.

While acknowledging some progress, Eliot concludes that housing providers must do more to ensure widespread integrated services: "[There is] still a considerable amount of uncertainty. The challenge for the sector and for us as a national body is to stay fully engaged and be trying out and experimenting with different relationships."

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